肿瘤患者的营养治疗

doi:10.11904/j.issn.1002-3070.2024.06.010

实用肿瘤学杂志 ›› 2024, Vol. 38 ›› Issue (6): 417-420.doi: 10.11904/j.issn.1002-3070.2024.06.010

肿瘤患者的营养治疗

李群^1,2, 石汉平^1,2 综述, 杨柳青^2,3 审校

1.首都医科大学附属北京世纪坛医院普外四科/肿瘤营养与代谢中心(北京 100038);
2.国家市场监管重点实验室(肿瘤特医食品);
3.首都医科大学附属北京世纪坛医院临床营养科

收稿日期:2024-08-26 修回日期:2024-11-14 出版日期:2024-12-28 发布日期:2025-01-06
通讯作者: 杨柳青,E-mail:18514592767@163.com
作者简介:李群,女,(1990-),本科,主管护师,从事肿瘤营养相关的研究。
基金资助:
国家重点研发计划项目(编号:2022YFC2009600)

Nutritional therapy for cancer patients

LI Qun^1,2, SHI Hanping^1,2, YANG Liuqing^2,3

1. The Department of General Surgery/Center for Cancer Nutrition and Metabolism,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;
2. Key Laboratory of Cancer FSMP for State Market Regulation;
3. Department of Clinical Nutrition,Beijing Shijitan Hospital,Capital Medical University

Received:2024-08-26 Revised:2024-11-14 Online:2024-12-28 Published:2025-01-06

摘要/Abstract

摘要： 肿瘤患者是营养不良的高危人群。摄入减少、吸收障碍、利用异常、消耗增加以及需求升高是导致肿瘤患者营养不良的主要原因。营养不良会导致抗肿瘤治疗耐受力降低、患者生活质量下降、生存时间缩短以及医疗费用增加等不良结局。因此,规范的肿瘤患者营养治疗应成为肿瘤综合治疗的重要内容并贯穿肿瘤患者生命全周期。本文就营养治疗的适应证、治疗时机与时程、治疗目标、五阶梯治疗方法、肿瘤患者的能量与蛋白质需求、肿瘤特异性营养配方特点以及营养治疗有效性评价等方面进行阐述,以期为临床肿瘤患者营养治疗提供指导。

关键词: 营养治疗, 肿瘤患者, 代谢调节

Abstract: Cancer patients are a high risk group for malnutrition.The decreased intake,impaired absorption,abnormal utilization,increased consumption and increased demand are the main causes of malnutrition in oncology patients.Malnutrition can lead to adverse outcomes such as reduced tolerance to anti-cancer therapy,decreased quality of life for patients,shortened survival time,and increased medical costs.Therefore,standardized nutritional therapy for oncology patients should become an important part of comprehensive cancer treatment and be carried out through the entire life cycle of cancer patients.This article describes the indications,timing and duration of nutritional therapy,treatment goals and the five-step therapeutic approaches,the energy and protein requirements of oncology patients,the characteristics of tumor-specific nutritional formulas,and evaluation of the effectiveness of nutritional therapy,in order to provide guidance for clinical nutritional therapy for cancer patients.

Key words: Nutritional therapy, Cancer patients, Metabolic regulation

中图分类号:

R730.5

李群, 石汉平, 杨柳青. 肿瘤患者的营养治疗[J]. 实用肿瘤学杂志, 2024, 38(6): 417-420.

LI Qun, SHI Hanping, YANG Liuqing. Nutritional therapy for cancer patients[J]. Journal of Practical Oncology, 2024, 38(6): 417-420.

参考文献

1 Bossi P,Delrio P,Mascheroni A,et al.The spectrum of malnutrition/cachexia/sarcopenia in oncology according to different cancer types and settings:a narrative review[J].Nutrients,2021,3(6):1980.
2 Bullock AF,Greenley SL,Mckenzie Gag,et al.Relationship between markers of malnutrition and clinical outcomes in older adults with cancer:systematic review,narrative synthesis and meta-analysis[J].Eur J Clin Nutr,2020,74(11):1519-1535.
3 Muscaritoli M,Arends J,Bachmann P,et al.ESPEN practical guideline:Clinical Nutrition in cancer[J].Clin Nutr,2021,40(5):2898-2913.
4 Guo ZQ,Yu JM,Li W,et al.Survey and analysis of the nutritional status in hospitalized patients with malignant gastric tumors and its influence on the quality of life[J].Support Care Cancer,2020,28(1):373-380.
5 Zhang M,Song H,Guo ZQ,et al.Sarcopenia prevalence in patients with cancer and association with adverse prognosis:anationwide survey on common cancers[J].Nutrition,2023,114:112107.
6 Yin L,Song C,Cui J,et al.Association of possible sarcopenia with all-cause mortality in patients with solid cancer:a nationwide multicenter cohort study[J].J Nutr Health Aging,2024,28(1):100023.
7 宋春花,王昆华,郭增清,等.中国常见恶性肿瘤患者营养状况调查[J].中国科学:生命科学,2020,50(12):1437-1452.
8 郭树彬,阮国添,石汉平.营养治疗是疾病的基础治疗、一线治疗[J].肿瘤代谢与营养电子杂志,2024,11(3):308-313.
9 李涛,吕家华.营养,肿瘤一线治疗的落实与思考[J].肿瘤代谢与营养电子杂志,2021,8(3):225-231.
10 中国抗癌协会,中国抗癌协会肿瘤营养与支持治疗专业委员会,中国抗癌协会.肿瘤营养治疗通则[J].肿瘤代谢与营养电子杂志,2016,3(1):28-33.
11 石汉平.肿瘤营养疗法[J].中国肿瘤临床,2014,41(18):1141-1144.
12 Malone A,Mogensen KM.Key approaches to diagnosing malnutrition in adults[J].Nutr Clin Pract,2022,37(1):23-34.
13 Lach K,Peterson SJ.Nutrition support for critically ill patients with cancer[J].Nutr Clin Pract,2017,32(5):578-586.
14 石汉平,李增宁,王昆华,等.营养管理新模式——HCH[J].肿瘤代谢与营养电子杂志,2015,2(3):23-26.
15 石汉平.整体营养疗法[J].肿瘤代谢与营养电子杂志,2017,4(2):130-135.
16 Liu Ca,Liu T,Ge Yz,et al.Muscle distribution in relation to all-cause and cause-specific mortality in young and middle-aged adults[J].J Transl Med,2023,21(1):154.
17 石汉平,于恺英,丛明华,等.恶性肿瘤营养不良的特征[J].肿瘤代谢与营养电子杂志,2020,7(3):276-282.
18 王林,丛明华,崔久嵬,等.肿瘤营养治疗的基本原则[J].肿瘤代谢与营养电子杂志,2022,9(6):727-734.
19 缪明永,石汉平.肿瘤脂代谢异常和脂代谢调节治疗[J].肿瘤代谢与营养电子杂志,2016,3(2):77-81.
20 董奕伶,殷峻.生酮饮食在肿瘤治疗中的研究[J].肿瘤代谢与营养电子杂志,2023,10(4):467-473.
21 张旭,孙迪,姜桂春.生酮饮食在肿瘤治疗中的临床应用进展[J].肿瘤代谢与营养电子杂志,2018,5(1):92-96.
22 石汉平,许红霞,李苏宜,等.营养不良的五阶梯治疗[J].肿瘤代谢与营养电子杂志,2015,2(1):29-33.
23 Arends J,Bodoky G,Bozzetti F,et al.ESPEN guidelines on enteral nutrition:non-surgical oncology[J].Clin Nutr,2006,25(2):245-259.
24 Bozzetti F,Arends J,Lundholm K,et al.ESPEN guidelines on parenteral nutrition:non-surgical oncology[J].Clin Nutr,2009,28(4):445-454.
25 Alberghina L.The Warburg effect explained:integration of enhanced glycolysis with heterogeneous mitochondria to promote cancer cell proliferation[J].Int J Mol Sci,2023,24(21):15787.
26 Fendt Sm.100 years of the Warburg effect:a cancer metabolism endeavor[J].Cell,2024,187(15):3824-3828.
27 Mathew M,Nguyen Nt,Bhytia Yd,et al.Metabolic signature of warburg effect in cancer:an effective and obligatory interplay between nutrient transporters and catabolic/anabolic pathways to promote tumor growth[J].Cancers(Basel),2024,16(9):1627.
28 Wand D,Duan Jj,Guo Yf,et al.Targeting the glutamine-arginine-proline metabolism axis in cancer[J].J Enzyme Inhib Med Chem,2024,39(1):2367129.
29 Wang J,Wang H,Gao M,et al.The regulation of amino acid metabolism in tumor cell death:from the perspective of physiological functions[J].Apoptosis,2023,28(9-10):1304-1314.
30 国家市场监管重点实验室(肿瘤特医食品),中国营养保健食品协会特殊医学用途配方食品应用委员会,中国抗癌协会肿瘤营养专业委员会.肿瘤患者特殊医学用途配方食品使用指南[J].肿瘤代谢与营养电子杂志,2022,9(5):572-580.
31 Kuroki K,Rikimaru F,Kunitake N,et al.Efficacy of beta-hydroxy-beta-methylbutyrate,arginine,and glutamine for the prevention of mucositis induced by platinum-based chemoradiation in head and neck cancer:a phase II study[J].Clin Nutr ESPEN,2023,57:730-734.
32 Okamoto K,Takamura H,Nagayama T,et al.Usefulness of perioperative nutritional therapy with the Glutamine/Arginine/Calcium β-Hydroxy-β-Methylbutyrate product in esophageal cancer surgery:a single-center retrospective study[J].Nutrients,2024,16(13):2126.
33 石汉平.营养治疗的疗效评价[J].肿瘤代谢与营养电子杂志,2017,4(4):364-370.
34 Arends J,Bachmann P,Baracos V,et al.ESPEN guidelines on nutrition in cancer patients[J].Clin Nutr,2017,36(1):11-48.
35 Muscaritoli M,Molfino A,Gioia G,et al.The “parallel pathway”:a novel nutritional and metabolic approach to cancer patients[J].Intern Emerg Med,2011,6(2):105-112.
36 Qiu Y,You J,Wang K,et al.Effect of whole-course nutrition management on patients with esophageal cancer undergoing concurrent chemoradiotherapy:a randomized control trial[J].Nutrition,2020,69:110558.
37 Movahed S,Norouzy A,Ghanbari-Motlagh A,et al.Nutritional status in patients with esophageal cancer receiving chemoradiation and assessing the efficacy of usual care for nutritional managements[J].Asian Pac J Cancer Prev,2020,21(8):2315-2323.
38 Holmes CJ,Racette SB.The Utility of body composition assessment in nutrition and clinical practice:an overview of current methodology[J].Nutrients,2021,13(8):2493.
39 缪明永.肿瘤患者高代谢及其机制的研究进展[J].肿瘤代谢与营养电子杂志,2022,9(2):168-174.

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肿瘤患者的营养治疗

Nutritional therapy for cancer patients

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